A 2014 analysis by the Health Policy Institute of Ohio (HPIO) showed the Buckeye State to be both unhealthy—Ohio ranked 40th in overall population health out of the 50 states and the District of Columbia—and financially indebted to healthcare, ranking 40th in the lowest health care costs. This suggests that the efficiency of the dollars the state spent on achieving a healthy population, measured as "health value," was very poor. In fact, Ohio ranked 47th in the nation in health value.
Three years later, HPIO is again assessing the population’s health to inform the creation of better public policy, with assistance from the Voinovich School of Leadership and Public Affairs. The result will be the 2017 Health Value Dashboard, an overview of the current status of health and healthcare in Ohio.
Ani Ruhil, associate professor, and Francesca Gordon, applied research professor, are heading the Voinovich School’s efforts to produce the 2017 dashboard. Ruhil is serving as project lead and Gordon is gathering and analyzing data to prepare the report. The pair are considering roughly 115 metrics from a diverse array of sources, associated with a few general categories: the quality of the healthcare system; public health and prevention; access to health care; social and economic environment; and, physical environment. These metrics are diverse, ranging from food insecurity to seatbelt use and income inequality. For each metric, the states are ranked, and these rankings are then averaged to produce the overall rankings for population health, health care costs, and health value.
Approximately 75 to 90 percent of the metrics assessed will be the same as those used in 2014. Therefore, the 2017 report will compare directly with the findings of the previous dashboard, demonstrating whether Ohio has improved or regressed on the issue of healthcare. At this stage of the project, however, it’s still unclear.
“Many things contribute to the poor health outcomes we’ve seen in Ohio,” Gordon said. “Nothing jumps out as the main driver. So, it’s too soon to say whether we’ve improved or not.”
However, the state of Ohio directly considered the results of the 2014 dashboard, inviting the HPIO to testify on the document at the Joint Medicaid Oversight Committee and both the Senate Health and Human Services and the House Health committees. The dashboard informed the policies then produced by the state in its response to issues such as infant mortality and tobacco-use prevention. Therefore, improvement is expected in some areas. However, a bigger question will be whether underlying dynamics of income inequality and educational access have changed in Ohio.
“Typically, if you look at any adverse behavior such as drinking or smoking, it will always be the case that the wealthier and more educated you are, the better access you have to health care and goods such as healthy food,” Ruhil said. “It invariably comes down to education and income.”
Gordon expanded upon this point.
“In the moderate range of income, one’s education is an important predictor of health, and in the moderate range of educational attainment, one’s income becomes really important,” she said. She went on to note, however, that more often than not, education and income are highly related: “If you haven’t finished high school, there will be a significant difference in what kind of job you can get.”
A new component of the 2017 dashboard will be its emphasis on disparities in health and health care between racial groups, which would hopefully draw the state’s attention to the groups most in need of assistance, Ruhil and Gordon said.
In regard to the impact their analysis would have, Ruhil said, “It all depends on what the state thinks is a priority, but without a dashboard such as this one that monitors how we’re doing, it’s impossible to keep track of any progress or regression that results. We need to pay attention to the right things.”
By situating Ohio within a national context, Gordon says she hopes the state can learn from others in the nation.
“We’ve been able to look at which states are doing the best on individual metrics,” she said. “Finding out who’s doing well could show us programs that have been working. In Identifying things that have been working, we can give people a way to use the data we collect here.”
Ruhil also stressed the importance of applying the report’s findings.
“In the end, we hope this will shape state policy, even if it’s just drawing the attention of policy-makers to a certain issue,” he said. “Therefore, this project shows the Voinovich School’s continuing contribution to the health of the region.”